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RICO Settlements: TMA's Leadership Against Payer Abuses Resulted in Relief, Reform - 04/09/2024

Back in 2001, the Texas Medical Association and the other plaintiffs alleged the nation’s major health plans had conspired to delay and reduce payments to clinicians and hospitals; the resulting lawsuits, brought under the federal Racketeer Influenced and Corrupt Organizations Act (RICO), represented a watershed moment in TMA history.

Exceptional Circumstances: TMA Advocates “Legislative Clarity” Amid State Abortion Bans - 03/05/2024

TMA advocates “legislative clarity” amid state abortion bans.

Blue Cross Says MOC Not Needed for BlueCompare - 02/28/2024

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.

TMA Wins Two More Surprise Billing Lawsuits; CMS Suspends Arbitrations - 10/03/2023

Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court on Aug. 24 struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

Fighting Back: Practice Wins Court Battle Over Defamatory Online Reviews - 06/20/2023

One practice’s recent legal battle epitomizes physicians’ worst nightmares when it comes to online reviews. Here’s an extreme but glaring real world example, straight from the documents in a lawsuit that Austin Eye first filed in October 2017 over

Blues to Expand HMO Network in January; Check Your Status - 10/21/2022

Blue Cross and Blue Shield of Texas (BCBSTX) will expand its MyBlue Health HMO network to six Texas counties starting in January.

Graphic Warnings on Cigarette Packs Face Ongoing Legal Challenge - 09/09/2022

A court order – once again – has upheld enforcement of the Food and Drug Administration’s rule that cigarette packs must contain more colorful and graphic health warnings. The new deadline for implementing the rule, per the court order, is Oct. 6, 2023.

Picking the Right Battles: TMA Stands Up for Medicine in the Courts - 06/29/2022

When a big point of legal contention arises – “big” meaning impactful for Texas physicians and their patients – the Texas Medical Association responds big. That’s been the case for decades, including in the courts. 

Dulling the Pain of Future Damages: High Court Ruling Addresses Periodic Payments - 05/31/2022

Texas Supreme Court decision carries new implications for periodic payment of future medical expenses.

Legal Legacies: TMA General Counsel Rocky Wilcox Retires After 42 Years of Service - 05/01/2022

After nearly five decades of service to organized medicine, Rocky Wilcox, the man behind TMA’s storied history of advocating for physicians and their patients through the legal and legislative systems is retiring. But the legacy he leaves behind has put physicians in Texas – even across the nation – on solid legal ground.

TMA Argues to Overturn Physician Dispensing Ban - 07/15/2021

Two Texas physicians are taking on the state’s general ban on physicians dispensing medications out of their offices, now with support from the Texas Medical Association for their argument that the prohibition does more to protect pharmacies than patient care.

Dispensing With Reason? Overturning State Ban on Providing Drugs From Physician Offices - 07/03/2021

Only a handful of states effectively ban physicians from dispensing medications out of their offices. Texas is one of them. Two Texas physicians have taken their case to the courts, arguing that the ban is unconstitutional because it does more to protect pharmacies than it does to protect patients. And TMA is lending its support to that argument.

Ruling Could Promote Frivolous Lawsuits, TMA Tells Texas Supreme Court - 06/13/2021

A recent appeals court decision could weaken a key piece of Texas’ 2003 medical liability reforms meant to cut frivolous lawsuits off at the head. In a friend-of-the-court brief filed last week, TMA and Texas Alliance for Patient Access (TAPA) tell the Texas Supreme Court that the law narrowly limits the amount of discovery – the exchange of information in a court case – before the person suing must produce an expert report. And there’s good reason for that, the groups say.  

Livelihood on the Line: Surgeon Sues Hospital over Alleged Disparagement, Malicious Peer Review - 06/10/2021

San Antonio cardiothoracic surgeon sues hospital over alleged disparagement, malicious peer. In less than two years, San Antonio cardiothoracic surgeon J. Marvin Smith III, MD, says his distinguished surgical career spanning about five decades was effectively wiped out.

Hospital Asks for Expedited Trial in Fort Worth Life-Sustaining Treatment Case - 04/30/2021

Believing that court-mandated, life-sustaining treatment is causing harm to a child in its care, Cook Children’s Medical Center in Fort Worth is attempting to resolve a highly publicized court case as quickly as possible.

Medicine Trains Its Sight on Scope Expansions - 04/01/2021

A court decision siding with chiropractors is the latest of many scope tests in the legislature and the law.

Outrageous Overreach Medicine Fights Broad Documentation Requests - 02/27/2021

When Andrew Indresano, MD, got a subpoena in January 2019, he found it “a little shocking” and “really invasive.” The Fort Worth orthopedic surgeon wasn’t even part of the personal-injury lawsuit for which he was being asked to produce a backward-looking swath of documents.

State Supreme Court Sides With Chiropractors on Neurological Test - 02/02/2021

The Texas Supreme Court has ruled that chiropractors can perform a diagnostic test used to evaluate a patient’s eye movements, a setback for medicine in a 10-year court battle.

Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.

Blue Cross HMO Emergency Payment Review Policy Begins - 11/16/2020

Beginning today, Blue Cross Blue and Shield of Texas will require some members to pay 100 percent of their medical bills if they go to an out-of-network emergency room for certain non-life-threatening conditions, company officials have confirmed.

See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.

Preserving Do No Harm: Supreme Court Tosses Challenge to Medical Ethics Committee Law - 10/13/2020

Twenty years after it took effect, Texas’ medical ethics committee review law has withstood challenge after challenge. The Texas Supreme Court is on the verge of ending the latest high-profile attack on the law that ensures physicians can uphold their professional obligation to “do no harm.” In October 2019, the state’s high court declined to take up Kelly v. Houston Methodist Hospital, in which the mother of a deceased patient attempted to overturn a provision of the Texas Advance Directives Act. Justices’ action leaves intact an appeals court decision that preserves physicians’ ability to use their medical judgment in end-of-life cases.

Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.

Charging Concierge Fees to BCBSTX Patients - 09/23/2020

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.

Some Clarity, Some Fog: AG Opines on Physician-Optometrist Relationship - 07/01/2020

An opinion by the Texas attorney general will keep the Texas Optometry Board (TOB) from exerting influence over the practice of medicine – to a certain point.